Prevalence and anatomical patterns of aortic arch branching variants on CT angiography in patients undergoing aortic valve surgery
AbstractBackground. Aortic arch branching variants represent a critical factor in cardiac surgical planning, influencing vascular access selection and cannulation strategy. Expanding indications for minimally invasive and transcatheter procedures have made precise preoperative arch imaging a prerequisite for procedural safety.
Objective. To evaluate the prevalence and spectrum of aortic arch branching variants on CT angiography in patients undergoing aortic valve surgery, as well as to retrospectively compare clinical and anthropometric parameters, treatment selection, and perioperative complication rates between those with normal and variant arch anatomy.
Patients and methods. Data from 158 patients (59 females, 99 males; median age 54 [38–67] years) who underwent aortic valve surgery between 2020 and 2024 were analyzed. All patients underwent thoracic CT angiography with 3D reconstruction. Branching patterns were classified according to the Natsis system with modifications. Comparative statistical analysis of clinical, anthropometric and anatomical parameters was performed.
Results. Normal aortic arch anatomy was observed in 131 patients (82.9%), while anatomical variants were detected in 27 (17.1%) cases. Of these, type 2b1 (bovine arch) was the predominant anomaly type revealed in 7 (25.9%) cases. Type 3b2 was identified in 5 (18.5%) patients. Types 2b2 (V-shaped), 4b1, and an aberrant right subclavian artery occurred with equal frequency in 4 cases each (14.8%). Types 2b3, 3b7, and right-sided aortic arch were each recorded in 1 (3.7%) case. Patients with arch anomalies were significantly older (median 59 vs 52 years, p=0.028) and had lower anthropometric indices. Branching type did not influence treatment choice (surgical replacement 77.3% vs TAVI 22.7%, p=0.79). Anatomical variants prolonged the procedural duration by 18±6 min and were associated with embolic complications: transient ischemic attacks in 2 (7%) cases, intraoperative stroke in 1 (3.7%) case. In an aberrant right subclavian artery, the distance from the prosthesis landing zone to the vessel orifice was an important anatomical parameter warranting preoperative assessment.
Conclusion. The prevalence of aortic arch branching variants was 17.1%, with type 2b1 predominating. Branching pattern did not determine the choice between surgical replacement and TAVI but was associated with increased technical complexity and embolic complications. In an aberrant right subclavian artery, the distance from the prosthesis landing zone to the vessel orifice is an important anatomical parameter that warrants preoperative assessment. CT angiography with 3D reconstruction is essential for identifying clinically relevant anatomical variants and assessing critical distances.
Keywords:anatomical variants; aortic arch branching; CT angiography; aortic valve
Authors’ contribution. Data collection and handling – Dariy O.Yu., Bogomolov D.A.; draft manuscript preparation – Dariy O.Yu., Bogomolov D.A.; manuscript revision – Revishvili A.Sh., Kondratiev E.V., Popov V.A., Malyshenko E.S., Gasangusenov M.G.
For citation: Dariy O.Yu., Kondratiev E.V., Popov V.A., Malyshenko E.S., Gasangusenov M.G., Bogomolov D.A., Revishvili A.Sh. Prevalence and anatomical patterns of aortic arch branching variants on CT angiography in patients undergoing aortic valve surgery. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 34–42. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-34-42
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